S. R. DiBrito1,2, I. Olorundare1,2, C. Holscher1,2, C. Haugen1,2, Y. Alimi2,3, D. Segev1,2 1Johns Hopkins University School Of Medicine,Transplant Surgery,Baltimore, MD, USA 2Johns Hopkins School Of Public Health,Baltimore, MD, USA 3Georgetown University Medical Center,Washington, DC, USA
Introduction: Cholecystectomy is one of the most commonly performed operations, and kidney transplant (KT) recipients are among those who require surgical management for cholelithiasis and cholecystits. Limited studies suggest that KT recipients have higher complication rates and longer length of stay (LOS) following general surgical procedures than non-transplant patients. This study investigates differences in complication rates, LOS, and cost between KT recipients and non-transplant patients undergoing cholecystectomy. Differences in outcomes following surgery at transplant centers vs non-transplant centers were also evaluated.
Methods: The Nationwide Inpatient Sample was used to study 7318 adult KT recipients and 5.3 million non-transplant patients who underwent cholecystectomy between 2000-2011. Postoperative complications were defined by ICD-9 code. Complication rates, LOS, and cost were compared using hierarchical logistic regression, hierarchical negative binomial regression, and mixed effects log-linear models respectively. Hospitals were categorized as transplant center if at least one transplant was performed during the follow-up period.
Results: On primary admission, the mortality rate for KT recipients was significantly higher than for non-transplant patients. (2.7 vs 1.2%, p <0.001). The rate of any postoperative complication was also higher (18.8 vs 13.9%, p <0.001). Following adjustment for patient and hospital level factors, mortality and complications both had increased odds in KT recipients respectively (OR 2.39, 95%CI 1.66-3.44; OR 1.30, 95%CI 1.12-1.51). Median length of stay was significantly longer in KT recipients compared to non-transplant patients (5 vs 3 days, p <0.001). After adjusting, the LOS ratio in KT recipients was still higher (OR 1.23, 95%CI 1.18-1.28). Median hospital costs were signficantly higher for KT recipients ($12077 vs $9002, p<0.001), and the higher cost ratio was still demonstrated after adjustment (ratio 1.14, 95%CI 1.10-1.18). There was no significant difference in any of the outcomes when comparing cholecystectomy performed at transplant center vs non-transplant center (Table 1).
Conclusion: KT recipients have higher mortality, more frequent postoperative complications, longer length of stay, and higher hospital costs than non-transplant patients undergoing cholecystectomy. Undergoing surgery at a transplant center makes no difference in outcomes when comparing KT recipients and non-transplant patients
